Monday, April 03, 2006

Traditional Cholesterol Test Results Are Different For People On Low-Carb

This question about my latest blood work numbers, namely my LDL and total cholesterol, and what they mean has sparked some very educational and varied opinions about what I should do about it since my doctor has given me four months to show improvements on my LDL or he wants me to get back on a statin drug again.

I received an e-mail from a gentleman today who said he has a theory about my lipid profile that my triglycerides are actually TOO LOW. I didn't think it was possible for your triglycerides to be "too low," but he shared his opinion about this with me.

"I have done extensive research on my 15 years of lipids data -- as well as a couple dozen friends & relatives. Only one other person besides you has failed to exhibit a 5 to 1 ratio between triglycerides and VLDL (my triglycerides were 42 and my VLDL was 8). Let's get those triglycerides back up to 50 or 60, so we can determine if my theory is correct!"

Intriguing theory to say the least. I still don't understand how and why all of this is important to the average person, but I'm attempting to learn more about it. I appreciate the theory, though, and I'm glad to be the monkey wrench that may prove this theory is correct.

Another regular and educated reader of my blog said to ditch the $1200 Berkeley Heart Test in favor of what is called the VAP (Vertical Auto Profile) Test by Atherotech. She said it is a much better test and is quickly becoming the standard alternative to Berkeley. The detailed breakdown of your cholesterol is very thorough and will give you a better idea about your risks rather than a generic HDL, LDL and total cholesterol. I will be conducting this test very soon on myself to see where I stand.

Getting the LDL pattern from the VAP test is very important or else your doctor is "flying blind," my reader said. That doesn't mean I'm out of the water on my LDL being so high just yet, but it does mean there needs to be a review of the breakdown of the LDL to see if action needs to be taken.

To get a better understanding of what I'm facing, I solicited the advice of a woman I greatly admire and respect for her work directly with patients on a low-carbohydrate health plan on a daily basis -- Dr. Mary Vernon. She shared with me her comments about my cholesterol numbers to help illuminate issues that I may not be aware of.

"These labs in which the LDL is calculated are not accurate if your triglycerides are below 100," she wrote in her e-mail. "The equation used to calculate these numbers makes assumptions which are not accurate when triglycerides are low."

My triglycerides are 42, a drop of 14 points (25%) from six months ago. The traditional method of cholesterol testing apparently does not factor in someone who is on a low-carb lifestyle. I wonder why that is? :-~

"Your total cholesterol and LDL can be elevated because intermediate density lipoproteins are being measured as LDLs," Dr. Vernon added. "You must also remember that your high HDL adds to your total."

You know, I didn't even think about there being an "intermediate" version showing up at LDLs. The VAP test will clarify that issue once and for all. Additionally, Dr. Vernon's comment about my high HDL number adding to my total cholesterol is a valid one indeed. If my HDL was back down in the lower 20s like it was before I started livin' la vida low-carb, then my total cholesterol would "only" be around 200, considered to be closer to "normal" cholesterol. How about that?

Another thought-provoking idea that I didn't know about is that the liver can secrete LDL into the blood when you VLDLs are "very low," Dr. Gannon stated.

"Although it floats at the same density as LDL, it does not imply the same outcome," she noted.

That, along with the "intermediate density lipoprotein," could artificially be elevating my LDL numbers. Again, this underlines the importance of having the VAP test done to shed light on the makeup of my LDL pattern.

Dr. Vernon pointed to the work of Dr. Jim Otvos from Liposcience who said his research has found that if a patient's triglycerides are 100 or below, then they automatically have the large fluffy LDL, the "non-dangerous type." Hmmmm, what do you think about that? With my triglycerides at 42, I feel confident based on Dr. Otvos' assessment that my LDL is healthy, but we'll know more after the VAP test.

Speaking candidly about this issue regarding cholesterol, Dr. Vernon said the way doctors today evaluate cholesterol is based on little to no understanding of the differences in a patient who is on a low-carb diet.

"One of the problems with this issue is that physicians are educated on the outcomes of constant storage metabolism and have no information about the risks or lack of risks associated with low carb," she explained. "I can tell you that I have several patients who have had no progression of cardiovascular disease after low carbing for several years."

Since Dr. Vernon works directly with people on low-carb daily in her work with patients, I am more apt to trust her empirical, anecdotal observations than the robotic response that most doctors are regurgitating to patients these days.

For more information about this topic, Dr. Vernon recommends a well-documented scientific article that appeared at the health web site Diabetes In Control written by Dr. Eric Freedland. This very lengthy and sometimes highly technical column will provide even more eye-opening information on this subject of cholesterol.

THANK YOU, Dr. Vernon, for sharing your wisdom with me and my readers today and keep up the great work on behalf of livin' la vida low-carb.

Finally, another gentleman shared an e-mail with me about having similar cholesterol numbers and vehemently opposed to taking a statin drug. He said to check out the writings of Anthony Colpo, Dr. Uffe Ravnskov, Drs. Michael and Mary Eades, as well as the International Network of Cholesterol Skeptics for more information on this debate over cholesterol.

This reader shared his commentary about the state of heart health in America that I thought was on topic.

"What is the cause of coronary atherosclerosis? The medical profession has defined this as 'the process of fatty substances, cholesterol, cellular waste products, calcium and fibrin building up in the inner lining of an artery. This buildup is called plaque, which can cause coronary heart disease.'

But what allows these substances to get into the inner lining of an artery? And what role, if any, does LDL have in the formation of plaque? It seems that a majority of the medical community believes LDL plays a significant role and must be controlled. But yet there are a number of scientists and medical professionals who say the ‘evidence’ does not support this conclusion. So where does that leave us? Read what the doubters have to say and form your own opinion."

I can think of no better ending to this discussion because I have made up my mind that there is a lot about my LDL and total cholesterol numbers that my doctor isn't telling me. While I don't think he's concealing information, I don't think he has had experience with someone following a low-carb dietary approach. I think it's high time we educate him.

I'll keep you informed about the results of my VAP test once I take it and get the results. THANKS again for the GREAT conversation on this issue.


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